Friday, October 26, 2018

Unusual sensory
responses (i.e., sensory over-responsivity, sensory under-responsivity, and
sensory seeking) are relatively common in children with autism spectrum
disorder (ASD) and when present, may interfere with performance in many
developmental and functional domains across home and school contexts. Sensory
issues are now included in the DSM-5 ASD symptom criteria for restricted,
repetitive patterns of behavior, interests, or activities (RRB), and include
hyper-or hypo-reactivity to sensory input or unusual interest in sensory
aspects of the environment; such as apparent indifference to pain/heat/cold,
adverse response to specific sounds or textures, excessive smelling or
touching of objects.It
should also be noted that sensory processing disorder (SPD) is not recognized
as a distinct diagnostic entity by the International Statistical
Classification of Diseases and Related Health Problems (ICD-10), Individuals with Disabilities Education Act (IDEA), or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Research

The use of sensory
integration therapy (SIT) for treatment of ASD has been both popular and
controversial. Although SIT is often used individually or as a component of OT
services for children with ASD, this intervention is best described as
unsupported.For example, a systematic
review of intervention studies involving the use of SIT concluded that the
current evidence-base does not support its use in the education and treatment
of children with ASD. The National Autism Center’s National Standards
Project also identifies SIT as an “Unestablished Treatment.”Likewise, the National Professional
Development Center on Autism Spectrum Disorders (NPDC) found “insufficient
evidence” for sensory diets and sensory integration and fine motor
intervention. Further, the American Academy of Pediatrics Section on
Complementary and Integrative Medicine and Council on Children with
Disabilities has issued a policy statement indicating that although OT with the
use of sensory-based therapies may be acceptable as one of the components of a
comprehensive treatment plan, parents and professionals should be informed that
the research regarding the effectiveness of SIT is limited and inconclusive.
They recommend that when utilized, interventions to address sensory related
problems should be integrated at various levels into the student’s
individualized educational program (IEP). The American Occupational Therapy
Association also suggests that practitioners utilizing a SIT approach use clinical
reasoning, existing evidence, and outcomes to create a comprehensive,
individualized approach for each client, rather than employing isolated,
specific sensory strategies. It is important to recognize that other OT
treatments which focus on improving functional skills (e.g., activities of
daily living) are essential for a range of neurodevelopmental disorders, thus
children with ASD should have access to those interventions when indicated.

In summary, the
current evidence-base does not support the use of SIT in the education and
treatment of children with ASD. Although SIT has been researched and practiced
for nearly 40 years, its underlying theory, accompanying diagnoses, and
treatments lack scientific support. At this time there no convincing research to
conclude that SIT and similar interventions promote improvement in behavioral
or social functioning of individuals with autism. Consequently, professionals
should present SIT as untested and encourage families who are considering this
intervention to evaluate it carefully. There is a need for more research using
scientifically robust, experimental methodologies with larger numbers of more
diverse participants to determine whether SIT should be termed an
evidence-based intervention. Future research should also investigate if SIT is
more or less effective than other interventions designed to reduce or overcome
sensory difficulties and whether specific individuals are more likely to
benefit from SIT than other individuals.

Practice

Despite the
paucity of research demonstrating the effectiveness of SIT, best practice
guidelines indicate that when needed, comprehensive educational programs for
children with ASD should integrate an appropriately structured physical and
sensory milieu in order to accommodate any unique sensory processing patterns.
Students with ASD frequently require accommodations and modifications to
prevent the negative effects that school and community environments can have on
their sensory systems. While many schools may find it difficult to make major
environmental changes, relatively simple adaptations and accommodations can be
implemented to lessen the impact of sensory issues on the student with ASD.
These include (a) reducing the amount of material posted on classroom wall for
a student who has problems with excessive visual stimulation; (b) teaching the
student to recognize the problem and ask in their mode of communication to
leave the area; (c) providing a low distraction, visually clear area for work;
(d) providing alternative seating and a quiet/calming space when students
become overwhelmed; and (e) using headphones or similar device to minimize high
noise levels. The accommodations and modifications needed to address sensory
issues should be specified in the student’s individualized educational program
(IEP). The collaboration of knowledgeable professionals (e.g., occupational
therapists, speech/language therapists, physical therapists, adaptive physical
educators) is necessary to provide guidance about supports and strategies for
children whose sensory processing and/or motoric difficulties interfere with
educational performance and access to the curriculum.

American Academy
of Pediatrics, Section on Complementary and Integrative Medicine and Council on
Children with Disabilities, Policy Statement (2012). Sensory integration
therapies for children with developmental and behavioral disorders. Pediatrics,
1186-1189. doi: 10.1542/peds.2012-0876. Available from
http://pediatrics.aappublications.org/content/early/2012/05/23/peds.2012-0876.full.pdf+html

American
Occupational Therapy Association. (2010). The scope of occupational therapy
services for individuals with an autism spectrum disorder across the life
course. American Journal of Occupational Therapy, 64 (Suppl.),
S125–S136.

National Academy
of Sciences (NAS), National Research Council, Division of Behavioral and Social
Sciences and Education, Committee on Educational Interventions for Children
with Autism. Educating Children with Autism. C Lord, JP McGee, eds. Washington,
DC: National Academies Press; 2001.

Thursday, October 18, 2018

Since Congress
added autism as a disability category to the Individuals with
Disabilities Education Act (IDEA), the number of students receiving special
education services in this category has increased over 900 percent
nationally. The number of students receiving assistance under the special
education category of autism over the past decade has increased from 1.5
percent to 9 percent of all identified disabilities. Autism now ranks fourth among
all IDEA disability categories for students age 6-21. It’s critically
important that school professionals understand the parameters of providing
evidence-based assessment and identification practices for children and
adolescents who may have an autism spectrum disorder (ASD).

The Individuals with
Disabilities Education Improvement Act of 2004 (IDEA) and the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are the two major
systems used to diagnose and classify children with ASD. The DSM-5 is
considered the primary authority in the fields of psychiatric and psychological
(clinical) diagnoses, while IDEA is the authority with regard to eligibility
decisions for special education. The DSM was developed by clinicians as a
diagnostic and classification system for both childhood and adult psychiatric
disorders. The IDEA is not a diagnostic system per se, but rather federal
legislation designed to ensure the appropriate education of children with
special educational needs in our public schools. Unlike the DSM-5, IDEA
specifies categories of ‘‘disabilities’’ to determine eligibility for special
educational services. The definitions of these categories (there are 13),
including autism, are the most widely used classification system in our
schools. According to IDEA regulations, the definition of autism is as follows:

(c)(1)(i) Autism means
a developmental disability significantly affecting verbal and nonverbal
communication and social interaction, generally evident before age 3, that
adversely affects a child’s educational performance. Other characteristics
often associated with autism are engagement in repetitive activities and
stereotyped movements, resistance to environmental change or change in daily
routines, and unusual responses to sensory experiences. The term does not apply
if a child’s educational performance is adversely affected primarily because
the child has an emotional disturbance, as defined in this section.

(ii) A child who
manifests the characteristics of ‘‘autism’’ after age 3 could be diagnosed as
having ‘‘autism’’ if the criteria in paragraph (c)(1)(i) of this section are
satisfied.

This educational
definition is considered sufficiently broad and operationally acceptable to
accommodate both the clinical and educational descriptions of autism and
related disorders. While the DSM-5 diagnostic criteria are professionally
helpful, they are neither legally required nor sufficient for determining
educational placement. A medical diagnosis from a doctor or mental health
professional alone is not enough to qualify a child for special education
services. It is state and federal education codes and regulations (not DSM-5)
that drive classification and eligibility decisions. In fact, the National
Research Council (2001) recommends that all children identified with ASD,
regardless of severity, be made eligible for special educational services under
the IDEA category of autism. Thus, school professionals must ensure that
children meet the criteria for autism as outlined by IDEA or state education
agency (SEA) and may use the DSM-5 to the extent that the diagnostic criteria
include the same core behaviors. All professionals, whether clinical or school,
should have the appropriate training and background related to the diagnosis
and treatment of neurodevelopmental disorders. The identification of autism
should be made by a professional team using multiple sources of information,
including, but not limited to an interdisciplinary assessment of social
behavior, language and communication, adaptive behavior, motor skills, sensory
issues, and cognitive functioning to help with intervention planning and
determining eligibility for special educational services.

Guidelines

Legal and special
education experts recommend the following guidelines to help school districts
meet the requirements for providing legally and educationally appropriate
programs and services to students who meet special education eligibility for
autism.

1. School districts
should ensure that the IEP process follows the procedural requirements of IDEA.
This includes actively involving parents in the IEP process and adhering to the
time frame requirements for assessment and developing and implementing the
student’s IEP. Moreover, parents must be notified of their due process rights.
It’s important to recognize that parent-professional communication and
collaboration are key components for making educational and program decisions.

2. School districts
should make certain that comprehensive, individualized evaluations are
completed by school professionals who have knowledge, experience, and expertise
in ASD. If qualified personnel are not available, school districts should
provide the appropriate training or retain the services of a consultant.

3. School districts
should develop IEPs based on the child’s unique pattern of strengths and
weaknesses. Goals for a child with ASD commonly include the areas of
communication, social behavior, adaptive skills, challenging behavior, and
academic and functional skills. The IEP must address appropriate instructional
and curricular modifications, together with related services such as
counseling, occupational therapy, speech/language therapy, physical therapy and
transportation needs. Evidence-based instructional strategies should also be
adopted to ensure that the IEP is implemented appropriately.

4. School districts
should assure that progress monitoring of students with ASD is completed at
specified intervals by an interdisciplinary team of professionals who have a
knowledge base and experience in autism. This includes collecting
evidence-based data to document progress towards achieving IEP goals and to
assess program effectiveness.

5. School districts
should make every effort to place students in integrated settings to maximize
interaction with non-disabled peers. Inclusion with typically developing
students is important for a child with ASD as peers provide the best models for
language and social skills. However, inclusive education alone is insufficient,
evidence-based intervention and training is also necessary to address specific
skill deficits. Although the least restrictive environment (LRE) provision of
IDEA requires that efforts be made to educate students with special needs in
less restrictive settings, IDEA also recognizes that some students may require
a more comprehensive program to provide FAPE.

6. School districts
should provide on-going training and education in ASD for both parents and
professionals. Professionals who are trained in specific methodology and
techniques will be most effective in providing the appropriate services and in
modifying curriculum based upon the unique needs of the individual child.

American
Educational Research Association, American Psychological Association, &
National Council on Measurement in Education. (2014). Standards for
educational and psychologicaltesting. Washington, DC:
American Educational Research Association.

National Association of School
Psychologists. (2016). School
Psychologists’ Involvement in Assessment. Bethesda, MD: Author.

National Research
Council (2001). Educating children with autism. Committee on Educational
Interventions for Children with Autism. C. Lord & J. P. McGee (Eds).
Division of Behavioral and Social Sciences and Education. Washington, DC:
National Academy Press.Ozonoff, S., Goodlin-Jones, B.
L., & Solomon, M. (2005). Evidence-based assessment of autism spectrum
disorders in children and adolescents. Journal of
Clinical Child and Adolescent Psychology,34, 523–540.

Twachtman-Cullen, D.,
& Twachtman-Bassett, J. (2011). The IEP from A to Z: How to create
meaningful and measurable goals and objectives. San Francisco, CA: Jossey-Bass.

Total Pageviews

Top 50 Autism Blog Award

Translate

Welcome

Thank you for visiting bestpracticeautism.com

The objective of bestpracticeautism.com is to advocate, educate, and informby providing a best practice guide to the screening, assessment, and intervention for school-age children on the autism spectrum. Timely articles and postings include topics such as screening, evaluation, positive behavior support (PBS), self-management, educational planning, IEP development, gender differences, evidence-based interventions (EBI) and more. This site also features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to organizations. Designed to be a practical and useful resource, bestpracticeautism.com offers essential information for psychologists, teachers, counselors, advocates and attorneys, special education professionals, and parents.

Best Practice Guide

Praise for "A Best Practice Guide..."

“It is rare that one book can pack so many resources and easy to digest information into a single volume! Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” - Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adult

“Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.” - Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University

“This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.” - Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA

Continuing Education (CE/CEU) Credit

Best Practice Autism Podcast

The Thrive with Apergers Podcast: Ovrecoming Anxiety and Depression on the Autism Spectrum

Disclaimer

BESTPRACTICEAUTISM.COM DOES NOT ENDORSE ANY TREATMENT, MEDICATIONS, OR THERAPIES FOR AUTISM. THE WRITTEN MATERIALS CONTAINED ON THIS SITE ARE FOR INFORMATIONAL PURPOSES ONLY.